Skip to main content

Acute Pain

At the time of diagnosis, 20%–75% of patients with cancer report having pain. Pain can be categorized as acute, chronic, breakthrough, or refractory and is caused by injury to body tissues (nociceptive) or damage to the peripheral or central nervous system (neuropathic).

Anorexia

Anorexia is the involuntary loss of appetite that has been reported to be as high as 80% in patients with various types of late-stage cancers. Anorexia is the most prominent symptom in the anorexia–cachexia syndrome that has been described in patients with cancer. ONS PEP resources address anorexia as a unique symptom separate from the entire cachexia syndrome.

Anxiety

Anxiety is an emotional and/or physiologic response that is a common experience among patients coping with any cancer diagnosis. Anxiety responses can range from normal reactions to extreme dysfunction that can affect decision making, adherence to treatment, and numerous aspects of quality of life and function. Anxiety can occur at different times throughout different phases of cancer care.

Breakthrough Pain

At the time of diagnosis, 20%–75% of patients with cancer report having pain. Pain can be categorized as acute, chronic, breakthrough, or refractory and is caused by injury to body tissues (nociceptive) or damage to the peripheral or central nervous system (neuropathic).

Caregiver Strain and Burden

Caregiver strain and burden encompasses the difficulties assuming and functioning in the caregiver role as well as associated alterations in the caregiver’s emotional and physical health that can occur when care demands exceed resources. Caregivers experience differing challenges during different phases of the cancer trajectory that can significantly impact their functioning and quality of life.

Chemotherapy-Induced Diarrhea

Diarrhea is an abnormal increase in stool liquidity and frequency that may be accompanied by abdominal cramping. Cancer-related diarrhea can be seen in patients with carcinoid tumors, carcinoid syndrome, gastrointestinal tumors, and hormone-producing tumors. Patients undergoing high-dose chemotherapy and patients receiving radiation therapy to abdominal and pelvic areas are more susceptible to diarrhea. Certain chemotherapy, biotherapy, and targeted therapies and regimens are associated with greater risk of diarrhea.

Chronic Pain

At the time of diagnosis, 20%–75% of patients with cancer report having pain. Pain can be categorized as acute, chronic, breakthrough, or refractory and is caused by injury to body tissues (nociceptive) or damage to the peripheral or central nervous system (neuropathic).

Cognitive Impairment

Cognitive impairment has been defined as a decline in function in one or multiple cognitive domains, including attention and concentration, executive function, information processing speed, language, visuospatial skill, psychomotor ability, and/or learning and memory. Patients with cancer often have referred to such problems as "chemo-brain" or "chemo fog," although patients who have not received chemotherapy also have reported this experience.

Constipation

Constipation is defined as the decreased passage of stool characterized by infrequent bowel movements, hard stool, sensation of abdominal bloating or cramping, straining with bowel movements, and feeling of incomplete evacuation. Constipation can be a symptom of the cancer itself because of pressure that can partially or totally occlude the bowel.

Depression

Symptoms such as depressed mood, diminished interest or pleasure in activities that were previously enjoyed, loss of energy, feeling of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicide are indicative of depression.

Dyspnea

Dyspnea is a subjective experience of difficult breathing or sensation of breathlessness that can occur rapidly and lead to a feeling of impending doom. Dyspnea can be common in patients with primary or metastatic lung or pleural involvement; however, patients with cancer without direct involvement of these areas also report it. Prevalence of dyspnea has been reported to be highest in patients with lung, breast, and esophageal cancer.

Fatigue

Cancer-related fatigue has been defined as a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to activity and interferes with usual function. Fatigue is one of the most common problems in patients with cancer. It may be related to the disease itself or cancer treatment and may continue beyond completion of treatment among long-term cancer survivors. Among people with cancer, 80% to 100% report experiencing fatigue.

Hot Flashes

Cancer treatment-related hot flashes may also be referred to as hot flushes, vasomotor symptoms, night sweats, and menopausal symptoms. A hot flash has been defined as a sensation of heat that may be accompanied by facial flushing, perspiration, chills, heart palpitations, night sweats, and feelings of anxiety. Hot flashes may be part of a symptom cluster that includes other problems such as fatigue and sleep disturbance.

Immunotherapy-Induced Diarrhea

Diarrhea is an abnormal increase in stool liquidity and frequency that may be accompanied by abdominal cramping. Cancer-related diarrhea can be seen in patients with carcinoid tumors, carcinoid syndrome, gastrointestinal tumors, and hormone-producing tumors. Patients undergoing high-dose chemotherapy and patients receiving radiation therapy to abdominal and pelvic areas are more susceptible to diarrhea. Certain chemotherapy, biotherapy, and targeted therapies and regimens are associated with greater risk of diarrhea.

Lymphedema

Lymphedema is the accumulation of lymph fluid that obstructs the flow of the lymphatic system, causing persistent swelling of the affected body part. In the oncology setting, the most common causes of lymphedema are radiation therapy and lymph node dissection. Lymphedema can occur in one or more extremities and can involve the corresponding quadrant of the trunk.

Mucositis

Mucositis is an inflammatory process that affects the mucous membranes of the oral cavity and gastrointestinal tract. ONS PEP resources focus on oral mucositis, which is estimated to occur in about 40% of patients secondary to chemotherapy and almost 100% of those receiving radiation for head and neck cancer. Approximately 80% of those undergoing hematopoietic stem cell transplantation will experience some level of oral mucositis.

Peripheral Neuropathy

Peripheral neuropathy refers to neurologic dysfunction that occurs outside of the brain and spinal cord. Patients with cancer are at risk for peripheral neuropathy caused by cancer, treatment, or both. Solid tumors can cause neuropathic symptoms and pain by pressing on local nerves. Chemotherapeutic agents that can cause peripheral neuropathy include epothilones, platinum analogs, taxanes, and vinca alkaloids.

Prevention of Bleeding

Bleeding in patients with cancer results from an interplay of disease- and treatment-related factors. Certain types of cancer such as leukemia have a higher probability of bleeding, with up to 90% of patients with acute promyelocytic leukemia developing hemorrhagic complications. Thrombocytopenia can be caused by chemotherapy or radiation therapy as well as infection, disseminated intravascular coagulation, liver disease, and platelet dysfunction.

Prevention of Infection: General

Cancer treatment with chemotherapy, radiation therapy, surgery, and biologic therapy puts patients at risk for development of infection. Compromised immune function associated with treatment can affect morbidity and mortality.

Prevention of Infection: Transplant

Cancer treatment with chemotherapy, radiation therapy, surgery, and biologic therapy puts patients at risk for development of infection. Compromised immune function associated with treatment can affect morbidity and mortality.

Radiation-Induced Diarrhea

Diarrhea is an abnormal increase in stool liquidity and frequency that may be accompanied by abdominal cramping. Cancer-related diarrhea can be seen in patients with carcinoid tumors, carcinoid syndrome, gastrointestinal tumors, and hormone-producing tumors. Patients undergoing high-dose chemotherapy and patients receiving radiation therapy to abdominal and pelvic areas are more susceptible to diarrhea. Certain chemotherapy, biotherapy, and targeted therapies and regimens are associated with greater risk of diarrhea.

Radiodermatitis

Radiodermatitis is the integumentary system's response to exposure to ionizing radiation. Short-term skin responses can range from erythematous rash to development of desquamation and necrosis. Late effects can appear months to years after radiation treatment and include pigmentation changes, telangiectasia, photosensitivity, fibrosis, atrophy, and delayed wound healing and other complications of surgery within the radiation treatment field.

Refractory/Intractable Pain

 

At the time of diagnosis, 20%–75% of patients with cancer report having pain. Pain can be categorized as acute, chronic, breakthrough, or refractory and is caused by injury to body tissues (nociceptive) or damage to the peripheral or central nervous system (neuropathic).

Skin Reactions

A number of different types of cutaneous reactions that affect the skin, hair, and nails can occur with cancer treatment. ONS PEP resources focus on those effects other than alopecia that are most often encountered, including rash, palmar-plantar erythrodysesthesia (PPE) (hand-foot syndrome), xerosis, paronychia, photosensitivity, and pruritus.

Sleep-Wake Disturbances

Sleep-wake disturbances are actual or perceived changes in night sleep with resulting daytime impairment. There are a number of demographic-, lifestyle-, environment-, disease-, and treatment-related factors that can increase the risk of sleeping problems in patients with cancer, including symptoms such as pain, nausea, anxiety, depression, and hot flashes.